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The effect of standardized exercise on the four-lead electrocardiogram
The
average
systolic
pressure
fell
slightly
over
a nerioJ
:oi’ ‘:h;rty-rive
minutes
aiJ
then
returned to the preinjection level; the average diastolic pressure fell to a maximum low point at forty-five minutes and remained near that level throughout he remaimler of the period. The average pulse pressure decreased. The average pulse rate rose. A degree of parallelism existed between changes in the systolic pressure and in rhe pulse rate of these patients, such that a rise in pressare was usually accompanied by a rise in pulse rate and a fall in systolic pressure may be primarily the result of cardiac stimulation by epinephrine, whereas, the fall in diast,olic pressure is attribmable to arteriolar dilatation. In forty hypertensive patients studied in a similar manner after receiving a. subcutaneous injection of pituitrin, a slight rise in average diastolic. pressure and an equally slight. fall in average systolic pressure were observed after twenty minutes. The average pulse rate was unchanged. In the same patient an unusual sarily accompanied by a vigorous
response response
to the injection to epinephrine.
of pituitrin
No constant or frequent deviation response to the subcutaneous injection strated in this series of patients with
from the reported normal of epinephrine and pituitrin essential hypertension.
H&s, Louis Pour-Lead
The Effect of Standardized J. M. Se. 189: 346, 1935.
N., and Landt, Electrocardiogram.
Harry: Am.
was not necescardiovascular
could
be demon-
Exe,rcis,e
on Se
Exercise tests were carried out in twenty patients having a history of angina pectoris on effort. The effect of the test on the four-lead electrocardiogram an;? on the development of angina was correlated with the appearance of the electrocariliogram at rest. The majority of the patients had abnormal electrocardiograms of varying degrees. Only four had four-lead electrocardiogramr?s within normal limits. Lead IV was never found to be abnormal when the other three leads were normal, but the reverse was true in many patients. One precaution generalized fatigue, the test was up.
was found to be essential, namely, to stop the exercise when dyspnea, cyanosis or angina1 pain appeared before the time fog
The appearance of the four-lead electrocardiogram taken at rest, the effect of a standardized exercise on the four-lead electrocardiogram, anii the effect of such an exercise in producing angina1 attacks are to be regarded as a triad which together augment the knowledge of the conrlition of the coronary circulation, obtained from clinical examination alone. The fact that positive findings by one of these three criteria can occur with negative findings by the other two shows the value of relying 3n a combination of all three, rather than on any one of them alone. There can be no doubt that tne fourth lead is a valuable addition to the other leads in carrying out this analysis. ~nir,
D.
C.? and
Bown,
J. W.:
Congenital
Heart
Disease.
Yrit.
M,
J.
1: i)ij!j,
1935. These remarks are based on observations and investigations of a series :,i: eases numbering over 200, during a period of some years. The eases are described in two groups, those without and those with cyanosis. The remarks relate to thu underlying anatomical conditions which produce the various physical signs ob3tirvecl in the patients. Diagnostic signs are discussed. It is shown that in most instances satisfactory antemortem diagnoses may be made.
average
systolic
pressure
fell
slightly
over
a nerioJ
:oi’ ‘:h;rty-rive
minutes
aiJ
then
returned to the preinjection level; the average diastolic pressure fell to a maximum low point at forty-five minutes and remained near that level throughout he remaimler of the period. The average pulse pressure decreased. The average pulse rate rose. A degree of parallelism existed between changes in the systolic pressure and in rhe pulse rate of these patients, such that a rise in pressare was usually accompanied by a rise in pulse rate and a fall in systolic pressure may be primarily the result of cardiac stimulation by epinephrine, whereas, the fall in diast,olic pressure is attribmable to arteriolar dilatation. In forty hypertensive patients studied in a similar manner after receiving a. subcutaneous injection of pituitrin, a slight rise in average diastolic. pressure and an equally slight. fall in average systolic pressure were observed after twenty minutes. The average pulse rate was unchanged. In the same patient an unusual sarily accompanied by a vigorous
response response
to the injection to epinephrine.
of pituitrin
No constant or frequent deviation response to the subcutaneous injection strated in this series of patients with
from the reported normal of epinephrine and pituitrin essential hypertension.
H&s, Louis Pour-Lead
The Effect of Standardized J. M. Se. 189: 346, 1935.
N., and Landt, Electrocardiogram.
Harry: Am.
was not necescardiovascular
could
be demon-
Exe,rcis,e
on Se
Exercise tests were carried out in twenty patients having a history of angina pectoris on effort. The effect of the test on the four-lead electrocardiogram an;? on the development of angina was correlated with the appearance of the electrocariliogram at rest. The majority of the patients had abnormal electrocardiograms of varying degrees. Only four had four-lead electrocardiogramr?s within normal limits. Lead IV was never found to be abnormal when the other three leads were normal, but the reverse was true in many patients. One precaution generalized fatigue, the test was up.
was found to be essential, namely, to stop the exercise when dyspnea, cyanosis or angina1 pain appeared before the time fog
The appearance of the four-lead electrocardiogram taken at rest, the effect of a standardized exercise on the four-lead electrocardiogram, anii the effect of such an exercise in producing angina1 attacks are to be regarded as a triad which together augment the knowledge of the conrlition of the coronary circulation, obtained from clinical examination alone. The fact that positive findings by one of these three criteria can occur with negative findings by the other two shows the value of relying 3n a combination of all three, rather than on any one of them alone. There can be no doubt that tne fourth lead is a valuable addition to the other leads in carrying out this analysis. ~nir,
D.
C.? and
Bown,
J. W.:
Congenital
Heart
Disease.
Yrit.
M,
J.
1: i)ij!j,
1935. These remarks are based on observations and investigations of a series :,i: eases numbering over 200, during a period of some years. The eases are described in two groups, those without and those with cyanosis. The remarks relate to thu underlying anatomical conditions which produce the various physical signs ob3tirvecl in the patients. Diagnostic signs are discussed. It is shown that in most instances satisfactory antemortem diagnoses may be made.